Review of the Year: Empty words?

How will political turmoil affect the government’s 2017 promises for the NHS and pharma?

There are mutterings in Westminster that, with so many politicians focused on Brexit, the day-to-day job of running the country is getting short shrift. For the healthcare system and life sciences, it is true that 2017 was a year that was remarkably light on legislation or reforms. Given the upheavals seen in some previous years, this may be welcome in some ways but it also means that problems in the healthcare system are accumulating.

The most acute of these is the clash between growing demand for health services and the continuing constraints on resources. The NHS is creaking badly, with staff morale extremely low and getting lower as gripes over wages and conditions accumulate. The decision to axe NHS bursaries for student nurses from August 2017 has certainly not helped, but David Cameron’s promise of a 24-hour NHS by 2020 is particularly resented, given that many GPs and hospitals are struggling to cope with the current workload and face growing recruitment problems as Brexit draws nearer.

All these issues hit the headlines around the June general election. Although healthcare was not as central to the debate as in previous elections, the vote was an opportunity for all parties to set out an agenda and promise some extra funding. The Conservative manifesto earmarked an extra £8 billion by 2020 (although it is not clear how this relates to the £10 billion already promised). It also pledged that NHS spending per head will rise in real terms every year of the government’s term to 2022. Meanwhile, all the parties came up with proposals that focused on GPs, preventative care and mental health, as well as social care.

The Conservatives focused in particular on mental health, promising an extra £1 billion in funding and the recruitment of 10,000 more mental health practitioners. They promised that they would support GPs, including recruitment, in exchange for the introduction of weekend and evening appointments starting in 2019. They also said they would set up a new independent healthcare safety investigations body, and extend the scope of the Care Quality Commission (CQC) to cover local authority health services.

With a dubious victory under its belt, the government followed up with the Draft Health Service Safety Investigations Bill, published in September 2017 and currently before Parliament. The CQC got some new powers, while in October the Department of Health issued new guidance on the Mental Health Act of 1983 – although a complete rewrite of the legislation will have to wait. For GPs, meanwhile, Jeremy Hunt (the health secretary) unveiled a package of measures in October that will include an indemnity scheme to cover medical negligence, golden hellos for new recruits, and flexible working practices.

The biggest bone of contention in the election, though, was social care, where the squeeze on funding has had knock-on effects for the NHS. Despite having given local councils more power to raise revenue, and raised funding by an extra £2 billion over the next two years, the Conservatives were under pressure to come up with a solution. But their notorious ‘dementia tax’ suggestion was probably one of the gaffes that lost them seats, and they appear to have shelved the plan to cap individuals’ spending on social care. There is still a cross-party consensus that social care funding needs urgent reform, including co-ordination with NHS care, but the planned consultation is unlikely before summer 2018.

The pharmaceuticals sector got its own set of promises in the election. They included implementation of the Accelerated Access Review to improve access to medicines, and to set up a new £23 billion National Productivity Investment Fund, to include pharma. There was also a promise to pay for continuing access to EU research funding, as well as funding all existing programmes to 2020, and a plan to raise R&D spending to 2.4 percent of GDP by 2027, then 3 percent long term.

Some of these policies were echoed in the proposed industrial strategy for the life sciences sector, published in August 2017 by Professor Sir John Bell. Its far-reaching recommendations, which are intended to turn the UK into a global hub for medical research and clinical trials, included a fund for ‘moonshot’ research, and to spawn four big new life sciences companies over the next ten years. The most immediate outcome of those government policies, however, has been November’s announcement that from next April a panel headed by Sir Andrew Witty will choose five experimental drugs a year to be pushed at speed through approval processes.

Even so, 2017 saw continued efforts to clamp down on pharmaceutical pricing. In April 2017 the government approved a new Health Service Medical Supplies (Costs) Act, which aligns the PPRS with the statutory scheme and increases cost controls for unbranded medicines. All parties in the supply chain must submit data proving that they are offering value for money. At an EU level, meanwhile, the medical devices sector got a long-promised overhaul as the EU Medical Device Regulations was published in May.

How that will be implemented in the UK, given Brexit, remains among the many questions for 2018 and beyond. The MHRA, too, will spend much of 2018 exploring its options about how to work with NICE and the EMA once the UK’s exit is finalised. Although the agency will want to use its new freedom to try to speed up access to innovation, it has already come down in favour of keeping most regulations as closely harmonised with the EU as possible. Otherwise, exports to the EU will be disrupted, as will local supply, given that the UK’s small market size could deter producers from launching or selling their products here. Even so, harmonisation will not prevent disruption unless it is combined with mutual recognition, including a deal over those products already approved. The details of this will need to be thrashed out over the coming 15 months.